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February 1995

Radiological Case of the Month

Author Affiliations

From the Department of Pediatrics, Section of Hematology-Oncology (Drs Kalra, Zoger, and Matthay) and the Department of Radiology (Dr Kosovich), the University of California—San Francisco.

Arch Pediatr Adolesc Med. 1995;149(2):195-196. doi:10.1001/archpedi.1995.02170140077012

A 3-YEAR-OLD BOY was admitted with a history of 3 days of fever, abdominal pain, and tachypnea and 1 day of coughing. Despite poor oral intake, he was well hydrated. Significant medical history was a diagnosis of stage IV neuroblastoma 28 months prior to this admission. Current medications included trimethoprim-sulfamethoxazole for Pneumocystis carinii prophylaxis.

At his initial presentation, he had a history of 5 weeks of fever, irritability, leg pain, and right periorbital ecchymosis. A computed tomogram (CT) of the head revealed a left protruding posterior skull lesion, a right maxillary sinus mass, and a right orbital mass. A CT scan of the abdomen revealed a mass in the upper-left quadrant arising from the left adrenal gland. A biopsy specimen of the maxillary sinus mass showed neuroblastoma; the urine vanillylmandelic acid level was elevated. Bone marrow aspirates and a biopsy specimen showed 50% infiltration with neuroblastoma cells. Subsequent treatment with